Nursing homes still struggle to get protective gear and quick testing
(CNN) -- Even inside nursing homes -- deemed a ground zero for the spread of coronavirus -- health care workers still don't have enough personal protective gear and the facilities can't get testing done quickly enough to effectively fight the virus.
At one of the largest nursing home chains in the United States, 45,000-bed Genesis Healthcare, the shortages of protective gowns for workers and the lack of quick testing has forced it to play catch-up to a rampaging infection rate, even while other needed supplies have become more accessible in the past few weeks.
"This is not a problem that by any stretch is remotely over," Genesis Healthcare CEO George Hager Jr. said last week.
The nursing home system has had more than 1,100 coronavirus cases among staff and more than 2,700 cases among its residents, amounting to more than 500 deaths as of Monday.
More than a month after Life Care Center in Kirkland, Washington, was designated the epicenter of the state's Covid-19 outbreak, nursing homes like Genesis' on the East Coast and across the country are seeing coronavirus cases and deaths climb in their facilities, as they still fight for access to protective gear and testing.
Over the past several weeks, the attention on supply shortages had largely focused on the availability of face masks and getting supplies to hospitals. Nursing homes, where severe cases of the virus spread especially easily, have been getting more help in recent weeks, depending on the state. But they're still facing a catastrophic situation.
"We, as a company, were very aggressive. We got ahead of things pretty quickly," Hager told CNN about how his nursing homes were able to have all employees wearing face protection by the week of March 26. "I would have liked to go (to all employees using masks and eye protection) sooner, but we just did not have adequate supplies."
Now, Genesis staff are reusing or laundering gowns if they can.
In normal times, each of the company's 400 nursing homes use four to eight isolation gowns on average per day. With the epidemic raging, each facility needs 140 gowns a day.
"We're talking about 20 (times) the usage. Every single day," Hager said. "When you see the hospital worker in the garbage bag -- that is the replacement for the isolation gown, unfortunately."
The Centers for Medicare and Medicaid Services on Monday was pushing for more transparency on case counts in nursing homes and giving advice on how the homes should abate flare-ups. The agency mandated that nursing homes tell patients, their families and the Centers for Disease Control and Prevention the extent of coronavirus cases within their facilities.
"Nursing homes have been ground zero for Covid-19," CMS administrator Seema Verma said, calling the new reporting requirement "critical" to monitoring the virus' spread and reopening the country.
Earlier this month, federal authorities pledged that "nursing homes have been a major focus for the Trump Administration in its aggressive efforts to combat the virus."
But tracking cases inside nursing homes would be just the beginning. Failures inside nursing home systems to get needed supplies have kept them from curtailing the spread of the virus.
So far, the Federal Emergency Management Agency is working on a plan to get nursing homes more supplies, Verma said on Sunday.
The American Geriatrics Society was still urging the Trump administration's coronavirus task force last week to prioritize protective equipment and testing supply shortages in nursing homes, long-term care facilities and other congregate living settings.
Joe DeMattos, the head of the Health Facilities Association of Maryland, which represents health care providers in nursing homes, said while most facilities today have adequate supply of some personal protective equipment, he's still hearing desperate pleas for medical gowns. "It's really cyclical," he said, and the need is going to continue.
A day ago, an assisted living facility called DeMattos asking for medical gowns, he said. "They had tried all of the government sources for gowns, the county, the state -- and they had come up short," he said. DeMattos obtained a handful of gowns for the nursing home from a nearby hospital.
While the Trump administration has promised a greater effort to help nursing homes, states like Maryland and Virginia have put in place special response teams.
More than half of Virginia's coronavirus outbreaks have stemmed from long-term care facilities, according to state health department data. About 15% of the state's 300 deaths have been reported from just from one facility, Canterbury Rehabilitation & Healthcare Center in Richmond, per health officials.
"It is a battle that at times we feel we're losing. It's a battle that we have fought, day and night, seven days a week," Dr. James Wright, the Canterbury nursing home's medical director, said in a recent news conference. "It's traumatic. It's traumatic for everybody."
Virginia Democratic Gov. Ralph Northam, when pressed by a reporter at a news conference last week, said that personal protective gear remained a serious challenge for the state -- even as Virginia sends aid to nursing homes to prevent shortages.
Dr. Danny Avula, director of the Richmond City and Henrico County Health Districts, where the Canterbury facility is located, explained that elderly care facilities continue to be hit so hard because testing, among other things, wasn't available. The entire state of Virginia had access to only 300 test kits at the start of March, he said.
"There's no doubt" the shortage of protective equipment also exacerbated the spread of the virus inside nursing homes, Avula told CNN. "But not because health care workers are doing something wrong and not wearing PPE when they're seeing an infected patient. More likely because they're not wearing PPE when they're seeing what they think is a non-infected patient," he said.
These nursing homes and assisted-living facilities find themselves particularly vulnerable to the spread of Covid-19 for several reasons, Fran Phillips, Maryland's Deputy Secretary of Public Health, told CNN.
"Covid is so infectious that we've seen that outbreaks in this population of older people can really accelerate incredibly fast," Phillips said. "It is the vulnerability of older people to fight off the virus." She added that the outbreaks are also due to asymptomatic transmission, which makes it very difficult to pinpoint.
In response, Phillips said, Maryland's Department of Health was trying to identify and address the spread of Covid-19 among Maryland's care facilities with what he called "go teams."
The teams, made up of members of the National Guard in concert with local and state health departments and medical professionals, have already responded to outbreaks in over 30 assisted care facilities, Republican Gov. Larry Hogan told reporters in a news conference last week. The teams are meant to assess what problems the nursing homes are facing, such as lack of protective supplies, testing, or more general infection control practices.
More testing needed
One of Maryland's teams that works on testing for nursing homes guarantees results within 24 hours for possibly infected residents and staff.
Maryland's response was praised nationally, with governors consulting Hogan about their own struggles to contain the virus in assisted care facilities, and Vice President Mike Pence identifying Maryland as a leader on the issue in a call with governors on Monday.
But the situation inside homes is still dire. In the Genesis nursing homes, testing for coronavirus still has a lag of three to four days. The wait for results was previously up to a week.
"We couldn't test people coming in on admission, coming from hospitals. We couldn't test people leaving our facility for lifesaving needs, like chemotherapy or dialysis. We couldn't test our employees who go back to their homes and run three shifts a day at work," Hager, the Genesis CEO said, said about the first few weeks of the pandemic in the US.
He noted how nursing homes were put in line behind the testing needs of hospitals. Yet even hospital care and lab industry leaders have raised alarms over the past few days about supply chain problems that prevent widespread testing for the virus in the US.
"We were all screaming to elevate our level of priority. The practical reality was there was not testing capacity, period," Hager said.
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